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Physiologic pseudoseizures: an EEG case report of mistake in identity.

Publication ,  Journal Article
Tatum, WO; Spector, A
Published in: J Clin Neurophysiol
June 2011

The misdiagnosis of epilepsy may occur from the misinterpretation of a routine scalp EEG. Typically, interictal epileptiform discharges are misidentified on EEGs because of the overinterpretation of normal variants or variations in normal electrocerebral activity. Most reports of misinterpretation have arisen from patients diagnosed with psychogenic nonepileptic attacks using in-patient video-EEG monitoring. However, because seizures are rarely captured in the routine performance of EEG in the outpatient setting, ictal overinterpretation is much less likely to occur. However, some physiologic conditions may also occur with paroxysmal hypersynchronous patterns on EEG and lead to a misdiagnosis of epilepsy. We report an adult woman with untreated obstructive sleep apnea and major depressive disorder that was self-referred for the evaluation of seizures. Brief episodes of delayed responsiveness associated with prolonged reading demonstrated the "generalized paroxysmal pattern" that was misinterpreted as a seizure during routine EEG at an outside institution. Subsequently, in-patient video-EEG monitoring reproduced multiple nonepileptic physiologic paroxysmal hypersynchronous arousals after prolonged reading. Treatment of the underlying sleep apnea, psychologic support, and limited prolonged reading lead to remission of her nonepileptic "spells" and successful discontinuation of antiepileptic drugs.

Duke Scholars

Published In

J Clin Neurophysiol

DOI

EISSN

1537-1603

Publication Date

June 2011

Volume

28

Issue

3

Start / End Page

308 / 310

Location

United States

Related Subject Headings

  • Sleep Apnea, Obstructive
  • Seizures
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans
  • Female
  • Electroencephalography
  • Diagnostic Errors
  • Diagnosis, Differential
  • 5203 Clinical and health psychology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tatum, W. O., & Spector, A. (2011). Physiologic pseudoseizures: an EEG case report of mistake in identity. J Clin Neurophysiol, 28(3), 308–310. https://doi.org/10.1097/WNP.0b013e31821c3dce
Tatum, William O., and Andrew Spector. “Physiologic pseudoseizures: an EEG case report of mistake in identity.J Clin Neurophysiol 28, no. 3 (June 2011): 308–10. https://doi.org/10.1097/WNP.0b013e31821c3dce.
Tatum WO, Spector A. Physiologic pseudoseizures: an EEG case report of mistake in identity. J Clin Neurophysiol. 2011 Jun;28(3):308–10.
Tatum, William O., and Andrew Spector. “Physiologic pseudoseizures: an EEG case report of mistake in identity.J Clin Neurophysiol, vol. 28, no. 3, June 2011, pp. 308–10. Pubmed, doi:10.1097/WNP.0b013e31821c3dce.
Tatum WO, Spector A. Physiologic pseudoseizures: an EEG case report of mistake in identity. J Clin Neurophysiol. 2011 Jun;28(3):308–310.

Published In

J Clin Neurophysiol

DOI

EISSN

1537-1603

Publication Date

June 2011

Volume

28

Issue

3

Start / End Page

308 / 310

Location

United States

Related Subject Headings

  • Sleep Apnea, Obstructive
  • Seizures
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans
  • Female
  • Electroencephalography
  • Diagnostic Errors
  • Diagnosis, Differential
  • 5203 Clinical and health psychology